Towards a better understanding of QT interval variability

Therapeutic Advances in Drug Safety

Volumn 2, Issue 6, 2011, Pages 245-251

  Tereshchenko, Larisa G ^a   Berger, Ronald D ^a  

^a JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

drug safety; QT interval; QT variability; ventricular tachyarrhythmias

Indexed keywords

EID: 84993683497     PISSN: 20420986     EISSN: 20420994     Source Type: Journal    
DOI: 10.1177/2042098611421209     Document Type: Review

References (73)

1. Alam I. Lewis M.J. Lewis K.E. Stephens J.W. Baxter J.N. (2009) Influence of bariatric surgery on indices of cardiac autonomic control. Auton Neurosci 151: 168–173.
2. Algra A. Tijssen J.G. Roelandt J.R. Pool J. Lubsen J. (1991) QTc prolongation measured by standard 12-lead electrocardiography is an independent risk factor for sudden death due to cardiac arrest. Circulation 83: 1888–1894.
3. Atiga W.L. Calkins H. Lawrence J.H. Tomaselli G.F. Smith J.M. Berger R.D. (1998) Beat-to-beat repolarization lability identifies patients at risk for sudden cardiac death. J Cardiovasc Electrophysiol 9: 899–908.
4. Atiga W.L. Fananapazir L. McAreavey D. Calkins H. Berger R.D. (2000) Temporal repolarization lability in hypertrophic cardiomyopathy caused by beta-myosin heavy-chain gene mutations. Circulation 101: 1237–1242.
5. Bar K.J. Boettger M.K. Koschke M. Boettger S. Groteluschen M. Voss A. (2007a) Increased QT interval variability index in acute alcohol withdrawal. Drug Alcohol Depend 89: 259–266.
6. Bar K.J. Koschke M. Boettger M.K. Berger S. Kabisch A. Sauer H. (2007b) Acute psychosis leads to increased QT variability in patients suffering from schizophrenia. Schizophr Res 95: 115–123.
7. Baumert M. Schlaich M.P. Nalivaiko E. Lambert E. Sari C.I. Kaye D.M. (2011) Relation between QT interval variability and cardiac sympathetic activity in hypertension. Am J Physiol Heart Circ Physiol 300: H1412–H1417.
8. Baumert M. Smith J. Catcheside P. McEvoy R.D. Abbott D. Sanders P. (2008) Variability of QT interval duration in obstructive sleep apnea: an indicator of disease severity. Sleep 31: 959–966.
9. Berger R.D. Kasper E.K. Baughman K.L. Marban E. Calkins H. Tomaselli G.F. (1997) Beat-to-beat QT interval variability: novel evidence for repolarization lability in ischemic and nonischemic dilated cardiomyopathy. Circulation 96: 1557–1565.
10. Bilchick K. Viitasalo M. Oikarinen L. Fetics B. Tomaselli G. Swan H. (2004) Temporal repolarization lability differences among genotyped patients with the long QT syndrome. Am J Cardiol 94: 1312–1316.
11. Carlsson L. (2008) The anaesthetised methoxamine-sensitised rabbit model of torsades de pointes. Pharmacol Ther 119: 160–167.
12. Cheng A. Dalal D. Fetics B.J. Angkeow P. Spragg D.D. Calkins H. (2009) Ibutilide-induced changes in the temporal lability of ventricular repolarization in patients with and without structural heart disease. J Cardiovasc Electrophysiol 20: 873–879.
13. Diaz M.E. O–Neill S.C. Eisner D.A. (2004) Sarcoplasmic reticulum calcium content fluctuation is the key to cardiac alternans. Circ Res 94: 650–656.
14. DuBuske L.M. (1999) Second-generation antihistamines: the risk of ventricular arrhythmias. Clin Ther 21: 281–295.
15. Echebarria B. Karma A. (2002) Instability and spatiotemporal dynamics of alternans in paced cardiac tissue. Phys Rev Lett 88: 208101.
16. Fenichel R.R. Malik M. Antzelevitch C. Sanguinetti M. Roden D.M. Priori S.G. (2004) Drug-induced torsades de pointes and implications for drug development. J Cardiovasc Electrophysiol 15: 475–495.
17. Franz M.R. Swerdlow C.D. Liem L.B. Schaefer J. (1988) Cycle length dependence of human action potential duration in vivo. Effects of single extrastimuli, sudden sustained rate acceleration and deceleration, and different steady-state frequencies. J Clin Invest 82: 972–979.
18. Gao S.A. Johansson M. Hammaren A. Nordberg M. Friberg P. (2005) Reproducibility of methods for assessing baroreflex sensitivity and temporal QT variability in end-stage renal disease and healthy subjects. Clin Auton Res 15: 21–28.
19. Garfinkel A. (2007) Eight (or more) kinds of alternans. J Electrocardiol 40: S70–S74.
20. Haigney M.C. Zareba W. Gentlesk P.J. Goldstein R.E. Illovsky M. McNitt S. (2004) QT interval variability and spontaneous ventricular tachycardia or fibrillation in the Multicenter Automatic Defibrillator Implantation Trial (MADIT) II patients. J Am Coll Cardiol 44: 1481–1487.
21. Hinterseer M. Thomsen M.B. Beckmann B.M. Pfeufer A. Schimpf R. Wichmann H.E. (2008) Beat-to-beat variability of QT intervals is increased in patients with drug-induced long-QT syndrome: a case control pilot study. Eur Heart J 29: 185–190.
22. Hondeghem L.M. Carlsson L. Duker G. (2001) Instability and triangulation of the action potential predict serious proarrhythmia, but action potential duration prolongation is antiarrhythmic. Circulation 103: 2004–2013.
23. Jensen B.T. Abildstrom S.Z. Larroude C.E. Agner E. Torp-Pedersen C. Nyvad O. (2005) QT dynamics in risk stratification after myocardial infarction. Heart Rhythm 2: 357–364.
24. Kamisako T. Adachi Y. Nakagawa H. Yamamoto T. (1995) Torsades de pointes associated with terfenadine in a case of liver cirrhosis and hepatocellular carcinoma. Intern Med 34: 92–95.
25. Kodama I. Kamiya K. Toyama J. (1997) Cellular electropharmacology of amiodarone. Cardiovasc Res 35: 13–29.
26. Kodama I. Kamiya K. Toyama J. (1999) Amiodarone: ionic and cellular mechanisms of action of the most promising class III agent. Am J Cardiol 84: 20R–28R.
27. Kuriki M. Fujino M. Tanaka K.I. Horio K. Kusuki H. Hosoi M. (2011) Ventricular repolarization lability in children with Kawasaki dDisease. Pediatr Cardiol 32: 487–491.
28. La Fountaine M.F. Wecht J.M. Rosado-Rivera D. Cirnigliaro C.M. Spungen A.M. Bauman W.A. (2011) The QT Variability Index and cardiac autonomic modulation: perspectives from apparently healthy men with spinal cord injury. Cardiology 117: 253–259.
29. MacConnell T.J. Stanners A.J. (1991) Torsades de pointes complicating treatment with terfenadine. BMJ 302: 1469.
30. Magri D. Piccirillo G. Bucci E. Pignatelli G. Cauti F.M. Morino S. (2010) Increased temporal dispersion of myocardial repolarization in myotonic dystrophy type 1 beyond the cardiac conduction system. Int J Cardiol 26 November [Epubahead of print].
31. Magri D. Sciomer S. Fedele F. Gualdi G. Casciani E. Pugliese P. (2007) Increased QT variability in young asymptomatic patients with beta-thalassemia major. Eur J Haematol 79: 322–329.
32. Maltsev V.A. Silverman N. Sabbah H.N. Undrovinas A.I. (2007) Chronic heart failure slows late sodium current in human and canine ventricular myocytes: implications for repolarization variability. Eur J Heart Fail 9: 219–227.
33. Maltsev V.A. Undrovinas A.I. (2006) A multi-modal composition of the late Na+ current in human ventricular cardiomyocytes. Cardiovasc Res 69: 116–127.
34. Merri M. Alberti M. Moss A.J. (1993) Dynamic analysis of ventricular repolarization duration from 24-hour Holter recordings. IEEE Trans Biomed Eng 40: 1219–1225.
35. Merri M. Benhorin J. Alberti M. Locati E. Moss A.J. (1989) Electrocardiographic quantitation of ventricular repolarization. Circulation 80: 1301–1308.
36. Merri M. Moss A.J. Benhorin J. Locati E.H. Alberti M. Badilini F. (1992) Relation between ventricular repolarization duration and cardiac cycle length during 24-hour Holter recordings. Findings in normal patients and patients with long QT syndrome. Circulation 85: 1816–1821.
37. Monahan B.P. Ferguson C.L. Killeavy E.S. Lloyd B.K. Troy J. Cantilena L.R. Jr (1990) Torsades de pointes occurring in association with terfenadine use. JAMA 264: 2788–2790.
38. Moss A.J. Schwartz P.J. Crampton R.S. Tzivoni D. Locati E.H. MacCluer J. (1991) The long QT syndrome. Prospective longitudinal study of 328 families. Circulation 84: 1136–1144.
39. Murabayashi T. Fetics B. Kass D. Nevo E. Gramatikov B. Berger R.D. (2002) Beat-to-beat QT interval variability associated with acute myocardial ischemia. J Electrocardiol 35: 19–25.
40. Murray K.T. (1998) Ibutilide. Circulation 97: 493–497.
41. Myredal A. Friberg P. Johansson M. (2010) Elevated myocardial repolarization lability and arterial baroreflex dysfunction in healthy individuals with nondipping blood pressure pattern. Am J Hypertens 23: 255–259.
42. Myredal A. Karlsson A.K. Johansson M. (2008) Elevated temporal lability of myocardial repolarization after coronary artery bypass grafting. J Electrocardiol 41: 698–702.
43. Nolasco J.B. Dahlen R.W. (1968) A graphic method for the study of alternation in cardiac action potentials. J Appl Physiol 25: 191–196.
44. Nollo G. Speranza G. Grasso R. Bonamini R. Mangiardi L. Antolini R. (1992) Spontaneous beat-to-beat variability of the ventricular repolarization duration. J Electrocardiol 25: 9–17.
45. Nussinovitch U. Katz U. Nussinovitch M. Nussinovitch N. (2010) Beat-to-beat QT interval dynamics and variability in familial dysautonomia. Pediatr Cardiol 31: 80–84.
46. Oosterhoff P. Oros A. Vos M.A. (2007) Beat-to-beat variability of repolarization: a new parameter to determine arrhythmic risk of an individual or identify proarrhythmic drugs. Anadolu Kardiyol Derg 7(Suppl. 1): 73–78.
47. Pastore J.M. Girouard S.D. Laurita K.R. Akar F.G. Rosenbaum D.S. (1999) Mechanism linking T-wave alternans to the genesis of cardiac fibrillation. Circulation 99: 1385–1394.
48. Piccirillo G. Magri D. Matera S. Magnanti M. Torrini A. Pasquazzi E. (2007) QT variability strongly predicts sudden cardiac death in asymptomatic subjects with mild or moderate left ventricular systolic dysfunction: a prospective study. Eur Heart J 28: 1344–1350.
49. Piccirillo G. Magri D. Ogawa M. Song J. Chong V.J. Han S. (2009) Autonomic nervous system activity measured directly and QT interval variability in normal and pacing-induced tachycardia heart failure dogs. J Am Coll Cardiol 54: 840–850.
50. Pueyo E. Husti Z. Hornyik T. Baczko I. Laguna P. Varro A. (2010) Mechanisms of ventricular rate adaptation as a predictor of arrhythmic risk. Am J Physiol Heart Circ Physiol 298: H1577–H1587.
51. Rock E.P. Finkle J. Fingert H.J. Booth B.P. Garnett C.E. Grant S. (2009) Assessing proarrhythmic potential of drugs when optimal studies are infeasible. Am Heart J 157: 827–836.
52. Roden D.M. (2004) Drug-induced prolongation of the QT interval. N Engl J Med 350: 1013–1022.
53. Roden D.M. (2008a) Cellular basis of drug-induced torsades de pointes. Br J Pharmacol 154: 1502–1507.
54. Roden D.M. (2008b) Repolarization reserve: a moving target. Circulation 118: 981–982.
55. Romero L. Pueyo E. Fink M. Rodriguez B. (2009) Impact of ionic current variability on human ventricular cellular electrophysiology. Am J Physiol Heart Circ Physiol 297: H1436–H1445.
56. Rosenbaum D.S. Jackson L.E. Smith J.M. Garan H. Ruskin J.N. Cohen R.J. (1994) Electrical alternans and vulnerability to ventricular arrhythmias. N Engl J Med 330: 235–241.
57. Schrickel J.W. Schwab J.O. Yang A. Bielik H. Bitzen A. Luderitz B. (2006a) Pro-arrhythmic effects of amiodarone and concomitant rate-control medication. Europace 8: 403–407.
58. Schrickel J.W. Schwab J.O. Yang A. Bitzen A. Luderitz B. Lewalter T. (2006b) –Torsade de pointes– in patients with structural heart disease and atrial fibrillation treated with amiodarone, beta-blockers, and digitalis. Pacing Clin Electrophysiol 29: 363–366.
59. Schwartz P.J. Wolf S. (1978) QT interval prolongation as predictor of sudden death in patients with myocardial infarction. Circulation 57: 1074–1077.
60. Shah R.R. Hondeghem L.M. (2005) Refining detection of drug-induced proarrhythmia: QT interval and TRIaD. Heart Rhythm 2: 758–772.
61. Shusterman V. Goldberg A. London B. (2006) Upsurge in T-wave alternans and nonalternating repolarization instability precedes spontaneous initiation of ventricular tachyarrhythmias in humans. Circulation 113: 2880–2887.
62. Speranza G. Nollo G. Ravelli F. Antolini R. (1993) Beat-to-beat measurement and analysis of the R-T interval in 24 h ECG Holter recordings. Med Biol Eng Comput 31: 487–494.
63. Straus S.M. Kors J.A. De Bruin M.L. van der Hooft C.S. Hofman A. Heeringa J. (2006) Prolonged QTc interval and risk of sudden cardiac death in a population of older adults. J Am Coll Cardiol 47: 362–367.
64. Tanskanen A.J. Greenstein J.L. O–Rourke B. Winslow R.L. (2005a) The role of stochastic and modal gating of cardiac L-type Ca2+ channels on early after-depolarizations. Biophys J 88: 85–95.
65. Tanskanen A.J. Greenstein J.L. O–Rourke B. Winslow R.L. (2005b) The role of stochastic and modal gating of cardiac L-type Ca2+ channels on early after-depolarizations. Biophys J 88: 85–95.
66. Tereshchenko L.G. Fetics B.J. Berger R.D. (2009a) Intracardiac QT variability in patients with structural heart disease on class III antiarrhythmic drugs. J Electrocardiol 42: 505–510.
67. Tereshchenko L.G. Fetics B.J. Domitrovich P.P. Lindsay B.D. Berger R.D. (2009b) Prediction of ventricular tachyarrhythmias by intracardiac repolarization variability analysis. Circ Arrhythm Electrophysiol 2: 276–284.
68. Thomsen M.B. Matz J. Volders P.G. Vos M.A. (2006) Assessing the proarrhythmic potential of drugs: current status of models and surrogate parameters of torsades de pointes arrhythmias. Pharmacol Ther 112: 150–170.
69. Thomsen M.B. Verduyn S.C. Stengl M. Beekman J.D. de Pater G. van Opstal J. (2004) Increased short-term variability of repolarization predicts d-sotalol-induced torsades de pointes in dogs. Circulation 110: 2453–2459.
70. Waring W.S. Graham A. Gray J. Wilson A.D. Howell C. Bateman D.N. (2010) Evaluation of a QT nomogram for risk assessment after antidepressant overdose. Br J Clin Pharmacol 70: 881–885.
71. Wu L. Shryock J.C. Song Y. Li Y. Antzelevitch C. Belardinelli L. (2004) Antiarrhythmic effects of ranolazine in a guinea pig in vitro model of long-QT syndrome. J Pharmacol Exp Ther 310: 599–605.
72. Yeragani V.K. Pohl R. Balon R. Jampala V.C. Jayaraman A. (2002) Twenty-four-hour QT interval variability: increased QT variability during sleep in patients with panic disorder. Neuropsychobiology 46: 1–6.
73. Yeragani V.K. Pohl R. Jampala V.C. Balon R. Ramesh C. Srinivasan K. (2000) Increased QT variability in patients with panic disorder and depression. Psychiatry Res 93: 225–235.